Ask the Pharmacist

Q: I have been hearing that more people are taking creatine supplements lately. I thought creatine was only for body-builders to improve their strength. Are there other benefits to creatine?

A: When most people hear about creatine, they often think of young athletes and weightlifters using it to bulk up or improve their gym performance. As much as some of us might be inspired to compete in the next Olympics, new research has found promising evidence for using creatine more for the average individual who is not looking to bulk up.

Creatine supplementation is now being investigated for its potential benefits on brain health, cognitive function, and even age-related muscle loss. As with any supplement, there are both potential advantages and drawbacks to taking creatine daily, and it may not be appropriate for everyone.

Firstly, creatine is a natural compound made in our bodies from amino acids, which are the building blocks of protein. About 95 per cent of our body’s creatine is stored in our skeletal muscle, with the remaining five per cent found in the brain and other tissues. We get creatine through our diet, particularly from meat and fish. Vegetarians/vegans, therefore, would struggle to add creatine to their diet.

Creatine helps supply energy to cells, especially during short bursts of intense activity. Our bodies use a molecule called ATP (adenosine triphosphate) as the primary energy currency. When the body requires energy, it converts its ATP into ADP (adenosine diphosphate) plus a free phosphate. The body can only store a small amount of ATP so the it needs to continually be regenerating its supply by allowing the ADP to recombine with the free phosphate to form ATP.

This is where creatine comes into play … by helping to regenerate ATP quickly, which is why athletes use it to boost strength and power output during high-intensity exercise. Therefore, it makes sense to see that some of the benefits of creatine involve our muscles.

However, there are other consequences of ATP depletion, such as fatigue and impaired nerve function. While this may sound as if it applies only to young, fit athletes, this reduced muscle function is just as important for older adults. Maintaining muscle is key to preserving mobility, balance, and independence as we age.

Here are some favourable effects of supplementing with creatine:
 

• Muscle strength and exercise performance
  • This is the area with the most evidence. Numerous studies have shown that taking a daily dose of three to five grams of creatine can:
    • Increase muscle strength and power.
    • Support lean muscle mass growth when combined with resistance training.
    • Help with short-duration, high-intensity activities, such as sprinting or weightlifting.
• Preserving muscle mass in older adults
  • Sarcopenia is an age-related loss of muscle mass and is a significant health issue for many older adults. It can lead to frailty, falls, loss of independence, and slower recovery from illness or injury.
  • Some studies suggest that older adults who take creatine while engaging in strength-training see greater improvements in muscle strength and function compared to those who only exercise. Even in the absence of intense gym work-outs, creatine may help maintain muscle energy stores and support daily physical activity.
• Brain health and cognitive function
  • This is one of the most exciting and newer areas of research. The brain, like muscles, uses a lot of energy. Creatine appears to support brain energy metabolism as well.
    Some early research has found that creatine supplementation may:
    • Improve memory and cognitive performance, especially during periods of mental fatigue.
    • Offer protective effects in certain neurological conditions under study (such as mild cognitive impairment or early neurodegenerative diseases).
    • Help reduce mental fatigue in stressful situations or sleep deprivation.

While these findings are still emerging, they point to a possible role for creatine beyond just physical performance. This is particularly relevant as maintaining cognitive health becomes a growing priority for older adults.

Creatine is also being studied as an adjunct therapy in various health conditions, including post-concussion recovery, muscular dystrophies, and chronic fatigue. Though not a treatment on its own, it may help support energy metabolism and recovery.

As often is the case with many supplements and medications, there are some possible drawbacks. While creatine is generally considered safe for most healthy individuals when taken at recommended doses, there are some important considerations:
 

• Water retention and weight gain - One of the first effects many people notice is mild weight gain, usually one to three pounds, due to water being drawn into the muscle cells. For most people, this is not harmful and may even help muscles look fuller, but it can be an issue for individuals trying to manage weight or for athletes in weight-class sports.
• Stomach upset - Some individuals may experience bloating, stomach cramps, or loose stools, especially if they take large doses at once. Dividing the dose or taking it with food can help minimize this.
• Kidney concerns - Creatine is broken down into a compound called creatinine, which is excreted by the kidneys. For people with normal kidney function, studies have not shown creatine supplementation at typical doses (three to five grams per day) to cause harm. However, individuals with pre-existing kidney disease or impaired kidney function should avoid creatine unless specifically advised by their health-care provider.
• Not a substitute for exercise or a balanced diet - While creatine can support muscle strength, it doesn’t build muscle on its own. Its benefits are maximized when paired with physical activity, particularly strength training or resistance exercise. Similarly, it is not a replacement for proper nutrition.

If you are considering taking creatine, it is suggested to take the powder form of creatine monohydrate since it is the most studied and cost-effective form. It can be taken any time of day, with or without food. Though some prefer after exercising, consistency is more important than timing. The typical dose is three to five grams daily.

Another note worth mentioning is, because creatine pulls water into the muscle cells, it is important to stay well-hydrated. Some regimens recommend high doses for the first week (20 grams per day) although this is truly not necessary. Taking a daily low-dose works just as well over time.

So, you might be wondering just who should consider taking creatine supplements and who should use caution and/or avoid creatine?

People who may consider supplementing with creatine:
 

• Adults who do resistance or strength training.
• Older adults who want to support muscle strength and function.
• Individuals looking for potential cognitive support (though research is still evolving).
• People recovering from certain injuries, such as concussions, under health-care supervision.

People who should avoid supplementing with creatine or use caution:
 

• Those with kidney disease or significant kidney impairment.
• Individuals who are unable to maintain adequate hydration.
• Anyone taking medications that affect kidney function, unless cleared by a health-care provider.
• Pregnant or breastfeeding individuals, since safety data is limited.

Remember, if you choose to take creatine powder, it is not a magic bullet, and it works best as part of a healthy lifestyle that includes physical activity and proper nutrition.

As with any supplement, it’s wise to check with a health-care provider or pharmacist before starting, especially if you have existing health conditions or take other medications. For many healthy adults, however, daily creatine supplementation can be a simple, relatively inexpensive way to support both physical and, potentially, cognitive health.

For more information about this or any other health-related questions, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination. Also check the website at www.gordon-pharmasave.com/ and the Facebook page at www.facebook.com/GordonPharmasave/.